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Operationalizing an Equity Lens in Community Health

August 15, 2018

Author: Alix Emden

Our mission at Medic Mobile is to support health workers as they provide care to those in the hardest-to-reach communities around the world. Equitable care and equitable health outcomes are key to our mission. Since 2016 we have been working with partners and researchers to develop and refine an Equity Lens for our digital toolkit, with a primary purpose of demonstrating what health systems are accomplishing -- and identifying what our tools can do to help the system perform even better for those who are most marginalized.

Our vision for the Equity Lens is holistic; we are working on means of accounting broadly for the social determinants of health, including measures of household wealth, gender, distance from health facilities, education level, as well as physical and mental abilities. A distinctive and defining feature of this vision is the idea that the systems we use to track information about health equity should be fully integrated with the digital tools we use to support routine care delivery. We have integrated this Equity Lens across three project sites in East and West Africa with the vision of supporting health systems that utilize equity data to inform strategies to provide care that reaches everyone.

Some equity-relevant data, such as gender or level of education, can be gathered by prompting health workers to ask simple questions at the point of care. However, gauging wealth is more challenging, and we soon realized that our work would benefit from an evidence-based, externally validated survey instrument for assessing household wealth. The EquityTool, supported by Metrics for Management (M4M), presented us with the a tested, community validated way to identify which households fall into each wealth quintile (i.e., bottom 20%, next 20%, next 20% etc.), relative to the broader population of a particular country. The EquityTool is a free, low-tech, scientifically-validated tool designed to help managers get the real-time data on client relative wealth that they need to adjust and improve service delivery.

Medic Mobile has partnered with Living Goods since 2014 to support their network of over 5,000 Community Health Workers (CHWs) across Kenya and Uganda with a custom, co-designed version of Medic Mobile’s open-source software, called the Smart Health app. Following discussions with Living Goods and the team at M4M, we decided to conduct a pilot analysis in three Living Goods branches in Kenya in 2017. We embedded the EquityTool questions into a simple digital form that CHWs already used to survey families within the existing Smart Health application. Through this relatively straightforward form integration, we were able to obtain essential demographic information about the population served by 1,400 Living Goods-supported CHWs, including the family’s relative household wealth. By collecting this information alongside service delivery information and health data, our goal was to support CHWs to improve and tailor care provided at the patient doorstep.

Medic Mobile’s CEO, Josh Nesbit, recently spoke on a panel at Aspen Institute. He highlighted the importance of ensuring equity is factored in when designing and implementing programs in local health systems, “I think it's high time for an equity lens to be part of the monitoring and management systems. To see this data not every five years, not with a retrospective survey, and not nationally, but to have this data coming in every month for ten thousand families.”

We’re excited to be moving health systems in this direction, and grateful to Metrics for Management and Living Goods for partnering with us in this ongoing work.